The government is on track to complete just 32 of its promised 40 new hospitals by 2030 under an overbudget and hard-to-deliver program that could result in medical facilities being ‘too small’, according to a “damning” report.
The National Audit Office (NAO) has completed an investigation into the scheme, initiated by the 2019 Conservative manifesto and reaffirmed in October 2020.
The report sets out the multiple challenges the government faces in delivering on a promise made for the first time by Boris Johnson and often taken up by the Conservative Party ever since.
The survey found the government is now on course to miss the commitment of 40 hospitals by 2030 – with at least eight facilities set to miss the end of the decade target, and it also set evidence of problems with a government plan to use pre-built, mass-produced hospitals. who could see patients unable to be treated.
Shadow Health Secretary Wes Streeting called the results “shocking” and “devastating”.
A map showing the location of the 40 new hospitals. Photo: National Audit Office
The promise
A key tenant of Mr Johnson’s 2019 election victory was a pledge to build 40 new hospitals.
Even back then, there were questions about what it actually meant and how feasible it was.
In October 2020 Mr Johnson said he wanted to build the new hospitals by 2030. In November 2020 Rishi Sunak – then chancellor – told parliament they were increasing capital spending to “fund the biggest hospital building program for a generation – building 40 new hospitals and upgrading 70 others”.
The NAO points out that after Mr Sunak’s announcement, the definition of a new hospital was changed to include a completely new hospital, a new building or a new clinical wing, or a major renovation and modification of “any except the main structure of an existing hospital”.
The audit also points out that at the time of Mr Johnson’s appointment in October, “for most programs the issue of affordability had not yet been considered”.
The report said the plan to build the 40 new hospitals by 2030 was always “liable” to change the timing or scope, and “this was not made clear to the public at the time.”
May 2023: Barclay insists target of 40 hospitals will be met
Health Secretary Steve Barclay in one of the few completed hospitals
What is built?
The program was initially divided into four cohorts, although it was later expanded to five.
A total of 48 hospitals make up the cohorts, as eight facilities already had plans in place.
Of the eight projects in the first cohort, only one counts in the total of 40 – because the other seven were already underway.
The other four cohorts are not expected to begin construction until at least next year, with one of the cohort two projects also constituting the previously planned eighth hospital.
The third and subsequent cohorts are set to use “hospital 2.0” guidelines – where hospital and building plans are standardized and partially done off-site.
Plans for this project have not yet been released and the construction industry is concerned about the feasibility of construction.
In addition, the NAO criticized the lack of transparency in how the 40 new projects were chosen, saying there was “a failure in record keeping” and that they cannot say how the hospitals been chosen.
August 2022: the majority of the 40 hospitals are unlikely to be completed by the next election
Boris Johnson promised hospitals in 2019 and again in 2020
Hospitals “too small”
As part of its design for the new “Hospital 2.0”, the government has drawn up plans for what would be the minimum viable hospital – the cheapest operational facility.
But the NAO warns that this specification risks being “too small”, and the estimated capacity of new hospitals is based on “perhaps unrealistic” assumptions about the number of people who can be discharged from hospitals for social care.
And government estimates that average stays will fall by 12% “seem poorly supported by evidence”.
Additionally, when the Department of Health and Social Care approached the Treasury for funding, it asked for £21.3bn but received £18.5bn instead.
In order to find savings, the government may have to move even more programs into the 2030s, or further lower the lowest specifications of new-style hospitals to save money, the NAO said.
December 2021: Johnson accused of calling renovations ‘new hospitals’
Click to subscribe to Sky News Daily wherever you get your podcasts
What are the delays?
One of the major delay factors, according to the NAO, is the problem of autoclaved reinforced aerated concrete.
This material, which is widely used, has proven to be unsuitable for construction for the past thirty years.
As announced earlier this year, five additional hospitals with concrete have been added to the new hospital program.
According to the NAO, only 32 of the previously promised hospitals will now be completed by 2030 to make way for the five new projects – and the remaining eight will be completed over the next decade.
Even this estimate is generous, as it includes the regeneration of facilities not previously included and the splitting of a project into two parts to reduce the numbers from 31 to 32.
A lack of construction contractors was also raised – with infrastructure projects like HS2 and a lack of clarity on what designs will cause uncertainty.
Projects like HS2 consume building resources
When will they be built and how much will it cost?
The NAO has made an estimate of the costs and deadlines.
In 2020, the government estimated it needed between £20bn and £30bn to build the promised 40 hospitals – plus the eight already started – by 2030.
He wanted between £3.7bn and £16bn for the first five years – and received £3.7bn from the Treasury under Mr Sunak.
As such, the decision was made to do smaller projects first and aim to complete the big ones later in the decade.
In the first three years there was “slow progress” in hospitals – but three opened in June this year, although none of them were among the 40 new hospitals.
The other five suffered delays ranging from one to 16 months.
The second cohort was due to start in 2022, but as of May 2023 no building had started, although £11 million of pre-construction work had taken place.
The first of the 40 new hospitals should open at the end of 2023 and the second at the end of 2025.
Cohorts three and four were due to start in 2025, and the fifth later in the 2020s.
Now, the NAO estimates the third cohort won’t open until 2029 or 2030.
Please use Chrome browser for more accessible video player
The state of the NHS explained
In terms of cost, Cohorts One and Two increased by nearly 50%, exceeding £1.2 billion in total.
In addition to the £3.7billion for the first half of the 2020s, the Treasury said it would provide £18.5billion for the rest of the program – but that was only until 2031, and with the overrun, more money might become available.
Inflation will also eat away at the budget, and the NAO suggests the Treasury and Health Department may have to renegotiate budgets.
Gareth Davies, the head of the NAO, said: “The scheme has innovative plans to standardize hospital construction, delivering efficiency gains and quality improvements. However, under the definition used by the government in 2020 , it will now supply 32 rather than 40 new hospitals by 2030 .
“So far, delivery has been slower than expected, both for individual programs and for the development of the Hospital 2.0 model, which has delayed program funding decisions.
“There are important lessons for large programs to learn from the New Hospitals program experience to date. These include strengthening the business case process to improve confidence about affordability and delivery dates, and improved transparency for key decisions.”
Please use Chrome browser for more accessible video player
Blair on the current state of the NHS
Shadow Health Secretary Wes Streeting said: “This shocking report couldn’t be more damning for the failing New Hospitals scheme.
“The so-called 40 new hospitals are over budget, behind schedule and may be too small. Many are not ‘new’, some are not ‘hospitals’ and there are not 40. In fact, only one hospital is on track to be built by the next election.”
A DHSC spokesperson said: “The NAO report recognizes that despite changes to the original program, 40 new hospitals are still expected to be delivered by 2030 and commends the program’s innovative plans to standardize hospital construction. , achieve efficiencies and improve quality.
“We remain strongly committed to delivering these hospitals, which should now be backed by over £20bn of investment – helping to reduce waiting lists so people can get the treatment they need faster. Three new hospitals have already opened and more will open this year so that patients and staff can benefit from major new hospital buildings, equipped with the latest technology.”